The Greatest Proportional Increase in Hospitalizations Among U.S. Adults With Ulcerative Colitis was Observed in Hispanic Patients, and Those With Medicaid Insurance: An Analysis of the Nationwide Inpatient Sample

Abstract

Introduction: Ulcerative colitis (UC) is a chronic disease with significant morbidity. Hospitalizations among UC patients are key outcome measures as it relates to disease burden. We aim to evaluate annual trends and burden of disease among adults with UC hospitalized in the U.S. Methods: Using data from the 2007-2013 Nationwide Inpatient Sample, hospitalizations among U.S. adults with UC were identified using ICD-9 coding. Annual trends in UC-related hospitalizations were stratified by age, sex, race/ethnicity, and primary payer/insurance status. Comparison of disease burden between groups was analyzed by calculating the proportion of UC hospitalizations represented by each group and utilized chi-square testing. Results: From 2007-2013, 49,871 hospitalizations had a primary diagnosis of UC. During this period, the overall number of UC hospitalizations increased by 8.4%. UC hospitalizations increased by 11.8% in men (3,050 in 2007 to 3,410 in 2013) and increased by 6.0% in women (3,541 in 2007 to 3,755 in 2013). In 2013, the greatest burden was seen among UC patients age < 40 years, which represented 45.6% of UC hospitalizations, compared to 29.3% among those age 40-59 years (p<0.01) and 25% among those age 50 years and over (p<0.01). While the majority of UC hospitalizations were seen among non-Hispanic whites, the greatest increase in UC hospitalizations from 2007 to 2013 was seen amongst Hispanics (51.8% increase), followed by African Americans (47.5% increase), Asians (42.7% increase) and non-Hispanic whites (42.2% increase). In 2013, non-Hispanic whites represented 67% of all UC hospitalizations, compared to 11% in Hispanics (p<0.01), 10.6% in African Americans (p<0.01), and 1.8% in Asians (p<0.01). From 2007 to 2013 UC hospitalizations among Medicaid patients increased by 41.2%, whereas UC hospitalizations in commercially insured patients increased by 4.2%, p<0.01). In 2013, patients with commercial insurance represented 50% of UC hospitalizations compared to 22.6% amongst Medicare patients (p<0.01) and 13% amongst Medicaid patients (p<0.01). Conclusion: Among U.S. adults hospitalized for a primary diagnosis of UC from 2007 to 2013, there was a disproportionately greater increase in UC hospitalizations observed among Hispanics, among UC patients age < 40 years, and among UC patients covered by Medicaid insurance. However, non-Hispanic whites and patients with commercial insurance still represent the major burden of hospitalizations among UC patients.707 Figure 1. Trends amongst US adults with Ulcerative Colitis hospitalized from 2007 to 2013